ICU mortality reduced by non-oral vitamin D – meta-analysis

The Effect of Vitamin D Supplementation on Clinical Outcomes for Critically Ill Patients: A Systemic Review and Meta-Analysis of Randomized Clinical Trials

Front Nutr. 2021 May 4;8:664940. doi: 10.3389/fnut.2021.664940

Hejuan Shen 1 2, Yijun Mei 1 2, Kai Zhang 3, Xiaoya Xu 1 2

58% less mortality vs 8% for oral (Note: 8% was not statistically significant)

ICU patients are often are unable to get nutrients orally However, ICU patients need to get the benefit of Vitamin D as soon as possible     restoring Vitamin D levels BEFORE the ICU would be ideal,         Fewer days in hospital if 300,000 IU of vitamin D before brain surgery - RCT Feb 2021        and sometimes will eliminate having to go to the ICU Injection of vitamin D into muscle does avoid a poor gut,    but at the expense of a somewhat slow response Good options for vitamin D in the ICU appear to be: 1) Vitamin D water if a patient can sip 2) Vitamin D nanoemulsion if a person can swish it in mouth 3) Vitamin D nanoemulsion applied topically (face and/or arms)         Note: nanoemulsion form is new and is starting to be used in ICU and elsewhere            COVID-19 inflammation extinguished by Vitamin D nanoemulsion Vitamin D levels might be raised very quickly summary by VitaminDWiki Note: The founder of VitamDWiki planned to have nanoemulsion trials (swished in mouth, topical, and inhaled) in 2020, but COVID-19 happened 1. Poor guts need different forms of vitamin D has the following {include} 1. Getting Vitamin D into your blood and cells has the following chart 1. Items in both categories Trauma-surgery and Loading Dose: {category} 1. Injection category listing has items 1. Items in both categories Trauma-surgery and injection: {category}

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Purpose: Vitamin D deficiency is a common scenario in critically ill patients and has been proven to be associated with poor outcomes. However, the effect of vitamin D supplementation for critically ill patients remains controversial. Thus, we conducted a meta-analysis to evaluate the effect of vitamin D supplementation among critically ill patients.

Methods: Electronic databases PubMed, Embase, Scopus, and the Cochrane Library were searched for eligible randomized controlled trials between 2000 and January 2021. The primary outcome was overall mortality, and the secondary ones were the length of intensive care unit stay, the length of hospital stay, as well as the duration of mechanical ventilation. Subgroup analyses were performed to explore the treatment effect by type of admission, route of administration, dose of supplemented vitamin D, and the degree of vitamin D deficiency.

Results: A total of 14 studies involving 2,324 patients were finally included. No effect on overall mortality was found between vitamin D supplementation and control group [odds ratio (OR), 0.73; 95% CI, 0.52-1.03; I 2 = 28%]. The vitamin D supplementation reduced the length of intensive care unit stay [mean difference (MD), -2.25; 95% CI, -4.07 to -0.44, I 2 = 71%] and duration of mechanical ventilation (MD, -3.47; 95% CI, -6.37 to -0.57, I 2 = 88%).

In the subgroup analyses, the vitamin D supplementation for surgical patients (OR, 0.67; 95% CI, 0.47-0.94; I 2 = 0%) or through parenteral way (OR, 0.42 ; 95% CI, 0.22-0.82, I 2 = 0%) was associated with reduced mortality.

Conclusion: In critically ill patients, the supplementation of vitamin D has no effect on overall mortality compared to placebo but may decrease the length of intensive care unit stay and mechanical ventilation. Further trials are necessary to confirm our findings.